Slide 1 ___________________________________

Acute Care and ___________________________________

Comorbidities
Care of the Patient and Family ___________________________________
Desirri Arneson MSN RN

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Slide 2 Review ___________________________________

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Slide 3 ___________________________________
Acute Illness
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• Rapid onset
• Short duration
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• Communicable disease, non-communicable disease, injury
• Time sensitive to interventions
• Sensitive to effectiveness of interventions
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Slide 4 ___________________________________
Comorbidity
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• Acute worsening/exacerbation of a chronic disease
or
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• Chronic disease complicating an unrelated acute process
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Slide 5 ___________________________________
Comorbidities
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Slide 6 ___________________________________
Chronic vs. Acute Illness

Characteristics of Chronic
Illness
• Permanent impairment/deviation
from normal
• Irreversible pathological changes
• Residual disability
• Special rehabilitation required
• Need for long-term medical
and /or nursing managment
Characteristics of Acute
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Illness
• Unexpected
• Higher priority ___________________________________
• Reversible
• Need for short term treatment and
management
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Slide 7 ___________________________________

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Slide 8 Review 2800 ___________________________________

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bb
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Slide 9 ___________________________________
Review 2700 & 2800

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Slide 10 ___________________________________
• Provides immediate response
Acute Healthcare • Requires coordination of care
• Prevention of death and disability
Systems • Cost effective care delivery
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Prevention
& Primary Care ___________________________________

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Slide 11 ___________________________________
Types of • Comprehensive
Assessment head to toe & extensive history ___________________________________
• Focused
single body system
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• Emergency
ABCs
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Slide 12
Clinical Judgment: Prioritize Your Assessment
Focused
• Single system and related systems
• Specific to symptoms present
• Ongoing evaluation of patient
status and evaluation of a treatment
• Abbreviated history
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Emergency
• Rapid exam; primary survey
• Specific to stabilization of patient ___________________________________
• Life saving focus
• Pertinent information and direct
questions
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Slide 13 ___________________________________
Prioritizing Patient Care
ABCs
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Maslows Hierarchy ___________________________________

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Slide 14 ___________________________________
Collaborative Management Physical
Therapy

Strategies
• Utilize knowledge and expertise of others
Pharmacy
Resource
Nurse
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• Respiratory Therapy
•
•
Physical Therapy
Resource Nurses
Patient
• Rapid Response Team Members ___________________________________
• IV Team Respiratory
Therapy
MD

• MDs
• Pharmacy
Case
• Case Managers & Social Workers Management
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Slide 15 ___________________________________

Your patient is has a sudden loss of

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consciousness: What will you do?
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Slide 16 ___________________________________
Rapid Response Team
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• Acute emergency management of symptoms
• Interdisciplinary Team
• Reduction of CPR occurance, emergency ICU ___________________________________
admissions, postop adverse events
• Reduced length of stay
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Slide 17 ___________________________________
Communication
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SBAR

•
•
Situation – what is happening right now; why is patient here
Background - pertinent comorbidities and risks
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• Assessment – your pertinent/focused assessment
• Response – Follow up and plan
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Slide 18 ___________________________________
Nursing Process during a Rapid Response
Team: An Acute Approach ___________________________________
Emergency Assessment & Stabilization
Focused Assessment & Communication
Diagnosis - consider chronic comorbidities and acute illness
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Plan & Intervention
Evaluation
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Slide 19 ___________________________________
Evaluate
and ___________________________________
Differentiate

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Slide 20 ___________________________________
Support of Patient and Family during Acute
Illness and Emergencies
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• Offer choices

• Provide information and updates ___________________________________

• Be available

• Cultural and religious preferences ___________________________________

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Slide 21 ___________________________________
Best Practice Alert: Family
Presence ___________________________________

• Decreased anxiety
• Contribution and support to patient needs ___________________________________
• Closure

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Slide 22 ___________________________________
Coping with Loss
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• Denial Shock
• Anger
Protest
• Bargaining ___________________________________
Disorganization
• Depression
• Acceptance Reorganization
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Slide 23 ___________________________________

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Slide 24 ___________________________________
Living Until We Die
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 We will all die
 < 10% suddenly
 > 90% prolonged illness ___________________________________
 Time course is unpredictable
 Most have time to prepare ___________________________________

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Slide 25 ___________________________________

What are your concerns about being

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present at a death?
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Slide 26 ___________________________________
Barriers to End of Life Care
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• Cure = focus of health care
• Cultural and social issues
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•
Discomfort with addressing issues of death
Psychological barriers
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Slide 27 ___________________________________
Notes for the Nurse
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Know value set and
feelings about illness and death
Get appropriate support
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Understand boundaries
Be aware of personal availability ___________________________________

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Slide 28 ___________________________________
Signs of Approaching Death:
The Last 48 Hours
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1. Reduced LOC

5. Bubbling sounds in
2. Decreased Intake
throat and chest

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4. Mottling in legs and 3. Anuria or olgiuria
arms

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Slide 29 ___________________________________
Signs of Death
• Cessation of heart and respiration
• Pupils fixed and dilated ___________________________________
• No response to stimuli
• Eyelids open without blinking
• Decreasing body temperature
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• Jaw relaxed and slightly open
• Waxen pallor ___________________________________

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Slide 30 ___________________________________
On-going, Continuous Care
during End of Life
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Desires are honored.
Choice of services.
Pain control
Spiritual support ___________________________________
Continuity of caregivers
Stages of Grief: Acceptance of
loss ___________________________________

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Slide 31 ___________________________________
Nursing Care
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Continue to be a resource and advocate to
patient and family

Provide symptom management and assess for

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changes

Maintain a physical and emotional presence ___________________________________

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Slide 32 ___________________________________
Nursing Care at the Time of
Death
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Notify appropriate people
Accompany body to morgue
Decompress/Debrief ___________________________________
Regroup
Move on ___________________________________

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Slide 33 ___________________________________
Maintaining Cultural
Competence
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 Respecting differences
 Recognizing the significance of culturally-based
practices, values, beliefs, expectations and experiences
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 Understanding the uniqueness of experience, even
within culture
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Slide 34 ___________________________________

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Slide 35 ___________________________________
References
American Association of Critical Care Nurses. (2010). Family presence during resuscitation and invasive procedures.
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Retrieved from http://www.aacn.org/wd/practice/docs/practicealerts/family-presence- during-
resuscitation-invasive-procedures.pdf
Critical Care Nurse. (2013). Rapid response teams: Challenges, solutions, benefits.
http://ccn.aacnjournals.org/content/27/1/20.full
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014). Medical-surgical nursing: Assessment and
management of clinical problems (9th ed.). St. Louis, MO: Mosby. Pgs. 43-45, 72-76, 1598-1602, & 1675-1682.
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Prater, D., Lenox, S., Renner, M., Tallmadge, M., & Von Lunen, K. (Eds.). (2013). RN adult medical surgical nursing:
Edition 9.0: ATI. Pg. 13.
Prater, D., Lenox, S., Renner, M., Tallmadge, M., & Von Lunen, K. (Eds.). (2013). Fundamentals for
nursing: Edition 8.0: ATI. Review Chapters 7 & 8.

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